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Downloading a Form to Your Computer

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Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.

Select the folder you want to save the file in and then click "Save."

Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.

Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC. Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.

Documents

Document

Instructions

Updated: 7/2014

Purpose

To document the comparative findings of Form H1852, List of Resident Participants in the Supplemental Nutrition Assistance Program (SNAP), returned monthly by a drug and alcohol treatment/group living arrangement facility authorized representative (AR).

To report violations after conducting a site visit.

Procedure

When to Prepare

Complete Form H1853:

monthly, to document any reportable findings after evaluating the information on Form H1852, received monthly from a facility AR; and

to report violations after conducting a site visit.

If no findings, document "no findings."

Number of Copies

Complete an original and one copy.

Transmittal

Mail the copy to the program manager in charge of the case record. The program manager sends a copy to Eligibility Services Field Operations, Health and Human Services Commission, 909 West 45th Street, Mail Code: 992-6, Austin, TX 78751.

Form Retention

File the original in the facility's case file. Retain in the case file for five years.

Detailed Instructions

Enter the review month, date, advisor name and facility name.

Check either Yes or No based on the outcome of the evaluation of Form H1852.

If negative findings are discovered, enter the date a report was made to Eligibility Services Field Operations in state office.

Use the Summary of Findings section to document detailed findings reportable to Eligibility Services Field Operations in state office.